Are older patients satisfied with physician assistants and nurse practitioners?

OBJECTIVE: To determine how satisfied older American consumers are with physician assistant (PA) and nurse practitioner (NP) care. DESIGN: Cross-sectional national survey. SETTING: Noninstitutional, representative random sample of people aged 65 years and older. PARTICIPANTS: Medicare recipients from the 2000 and 2001 Medicare Satisfaction Survey, Consumer Assessment of Health Plans Survey section on Fee-for-Service, who identified a primary care provider. MEASUREMENTS: Patient sociodemographic characteristics, health care experience, and satisfaction data were compared in which a generalist physician, PA, or NP was identified as the personal provider. RESULTS: 146,880 completed returns from 321,407 randomly sampled Medicare beneficiaries nationwide (45.7% of the total surveyed) were analyzed with regard to satisfaction with their personal providers. Of this number, 3,770 identified a PA or an NP as their personal provider. For questions on satisfaction with their personal care clinician, results were similar for all three kinds of providers. A significantly higher proportion of the patients who reported NPs as their primary care providers were Medicaid recipients than were those patients who reported receiving care from PAs or physicians. Conversely, a significantly higher proportion of patients who were supplemental insurance recipients reported physicians as their primary care providers than were those who reported receiving care from PAs or NPs. CONCLUSION: Findings suggest that patients are generally satisfied with their medical care and do not distinguish preferences based on types of providers. PAs, NPs, and physicians in primary care seemed to be viewed similarly regardless of patient characteristics. PAs and NPs may be a workforce that could be expanded to care for the rising needs of the elderly.

Evaluating the effect of translation on Spanish speakers' ratings of Medicare.

This study examined the equivalence of the English and Spanish versions of the Medicare Consumer Assessment of Health Plans Study (CAHPS) fee-for-service (FFS) survey among 2,996 Hispanic Medicare beneficiaries. Multigroup confirmatory factor analyses indicated that with few exceptions the factor structures were very similar for the English and Spanish surveys. However, item response theory-based methods for investigating differential item functioning (DIF) revealed that several items demonstrated threshold-related DIF, suggesting that respondents in the two languages utilized the response options for the items differently. The results of this study suggest the need for future qualitative research to understand how respondents comprehend the response options in the two languages.

Variation in racial and ethnic differences in consumer assessments of health care.

BACKGROUND: Prior studies have documented significant racial and ethnic disparities in health and healthcare, but data about disparities from consumer assessments of care are inconsistent. OBJECTIVE: To examine racial/ethnic differences in consumer assessments and explore variation in such differences across health plans. METHODS: Data included 160694 Consumer Assessment of Health Plans Surveys (CAHPS) responses from 307 commercial health plans and 177 489 Medicare beneficiaries in 308 Medicare+Choice managed care plans collected in 1999. We compared adjusted mean CAHPS global rating and composite scores as well as access to and use of care reported by whites, blacks, Hispanics, and Asians. We assessed variation in the differences between plan means for whites and blacks and between whites and Hispanics. RESULTS: Three minority groups rated their health plans higher than whites on at least 1 measure. Blacks rated their care and doctors higher than whites, while Asians rated their care and doctors lower than whites. Blacks reported better experience with care than whites, but Hispanics and Asians reported worse experience than whites. However, all minority groups reported significantly larger problems with access to and less use of healthcare. The differences between blacks and whites, and blacks and Hispanics in CAHPS measures and access/use measures varied greatly from plan to plan. CONCLUSIONS: Significant race/ethnic differences in experience with, access to, and use of care exist in health plans. Substantial variation in racial differences suggests compromised quality of healthcare and opportunities for quality improvement.

Prescription medication cost-related non-adherence among Medicare CAHPS respondents: disparity by Hispanic ethnicity.

PURPOSE: We examined whether there was disparity in prescription medication cost-related non-adherence (CRN) by Hispanic ethnicity among Medicare enrollees. METHODS: Multivariate logistic regression, adjusting for race, other socio-demographic variables, health status, health care utilization, and patient rating of their personal physician, was used to examine association of Hispanic ethnicity with CRN using cross-sectional data from Medicare's Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey (data collected in Spring 2007). RESULTS: Hispanic respondents constituted 6.9% (unweighted n=22,304) of the analytic sample (unweighted n=272,701; response rate 5 48%). Overall, 13.4% of respondents reported CRN; among Hispanics and non-Hispanics, 20.3% and 12.9% reported CRN, respectively, p<.0001. Adjusted odds ratio (95% CI) of reporting CRN in the past six months was 1.18 (1.08, 1.29) for Hispanic compared with non-Hispanic respondents. CONCLUSIONS: Hispanic ethnicity was significantly associated with CRN. More research is needed to understand interventions to eliminate the disparity for this minority group.

The development of a CAHPS instrument for Nursing Home Residents (NHCAHPS).

We report on a federal initiative to develop a CAHPS (The Consumer Assessment of Healthcare Providers and Systems) survey to measure residents' experiences with quality-of-care and quality-of-life in nursing homes (known as NHCAHPS). We focus on how we created and tested questions for inclusion in the instrument and tested a possible cognitive screener to determine which residents could participate in a NHCAHPS interview. The major lessons learned were: (1) In contrast to other CAHPS surveys, ratings were more useful than reports because of the difficulty that residents had with summarizing over time and people; (2) consistent with other CAHPS surveys, the 0 to 10 response scale appeared to work well with nursing home residents for many of the quality-of-care questions; however, a different response scale was needed for many of the quality-of-life items; and (3) in contrast with typical survey methodology and other CAHPS surveys where explicit time reference periods are used, a non-specific present reference period in questions seemed to work best.